Case Discussion

Trauma   Posted By shafiq chughtai    Date : 23-Jul-10   03:19 AM     Reply

i am a resident in surgery and yesterday in Emergency i recieved a patient with bullet injury to the chest. he was 30 yrs old male , recieved a bullet injury (accidental) in the left chest at 6th intercostal space , mid clavicular line. At presentation , he was consious , oriented , with an intact airway , breathing was 26 / min , regular , central trachea with reduced breath sounds on left side.Pulse was 52 / min , blood pressure 100/70 mm Hg , heart sounds were not clearly audiable (muffled ?) , jvp was normal.There was palpable crepetus at the level of injury , abdomen otherwise was tense but not distended. We shifted the patient to ot , did fluid resuscitation and passed chest tube on left with 350 ml of blood stat.The patient had FAST which was negative for abdominal free fluid , the radiologist was not confident about the presence of cardiac temponade.X ray chest showed bullet in the chest , with intact cardiac margins , minimal blunting of left cardiothoracic angle. question : 1.whats the ideal investigationnin this patient , CT chest and abdomen and formal echocardiography? 2.Should we do a laprotomy in this patient to exclude hollow viscus / diaphram injury ? my consultant had the patient put on observation anfd after 12 hrs his vitals , cheast draions were static , he developed no abdominal signs.What i personelly feel is he should had a laprotomy atleast to exclude a diaphragmatic injury which can latter cause herniation / strangulation. Thanks shafiq chughtai Holy Famlily Hospital Rawalpindi Pakistan

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